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A Large Retrospective Assessment of Voriconazole Exposure in Patients Treated with Extracorporeal Membrane Oxygenation

Background: Voriconazole is one of the first-line therapies for invasive pulmonary aspergillosis. Drug concentrations might be significantly influenced by the use of extracorporeal membrane oxygenation (ECMO). We aimed to assess the effect of ECMO on voriconazole exposure in a large patient populati...

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Autores principales: Van Daele, Ruth, Bekkers, Britt, Lindfors, Mattias, Broman, Lars Mikael, Schauwvlieghe, Alexander, Rijnders, Bart, Hunfeld, Nicole G. M., Juffermans, Nicole P., Taccone, Fabio Silvio, Coimbra Sousa, Carlos Antônio, Jacquet, Luc-Marie, Laterre, Pierre-François, Nulens, Eric, Grootaert, Veerle, Lyster, Haifa, Reed, Anna, Patel, Brijesh, Meersseman, Philippe, Debaveye, Yves, Wauters, Joost, Vandenbriele, Christophe, Spriet, Isabel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8303158/
https://www.ncbi.nlm.nih.gov/pubmed/34361978
http://dx.doi.org/10.3390/microorganisms9071543
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author Van Daele, Ruth
Bekkers, Britt
Lindfors, Mattias
Broman, Lars Mikael
Schauwvlieghe, Alexander
Rijnders, Bart
Hunfeld, Nicole G. M.
Juffermans, Nicole P.
Taccone, Fabio Silvio
Coimbra Sousa, Carlos Antônio
Jacquet, Luc-Marie
Laterre, Pierre-François
Nulens, Eric
Grootaert, Veerle
Lyster, Haifa
Reed, Anna
Patel, Brijesh
Meersseman, Philippe
Debaveye, Yves
Wauters, Joost
Vandenbriele, Christophe
Spriet, Isabel
author_facet Van Daele, Ruth
Bekkers, Britt
Lindfors, Mattias
Broman, Lars Mikael
Schauwvlieghe, Alexander
Rijnders, Bart
Hunfeld, Nicole G. M.
Juffermans, Nicole P.
Taccone, Fabio Silvio
Coimbra Sousa, Carlos Antônio
Jacquet, Luc-Marie
Laterre, Pierre-François
Nulens, Eric
Grootaert, Veerle
Lyster, Haifa
Reed, Anna
Patel, Brijesh
Meersseman, Philippe
Debaveye, Yves
Wauters, Joost
Vandenbriele, Christophe
Spriet, Isabel
author_sort Van Daele, Ruth
collection PubMed
description Background: Voriconazole is one of the first-line therapies for invasive pulmonary aspergillosis. Drug concentrations might be significantly influenced by the use of extracorporeal membrane oxygenation (ECMO). We aimed to assess the effect of ECMO on voriconazole exposure in a large patient population. Methods: Critically ill patients from eight centers in four countries treated with voriconazole during ECMO support were included in this retrospective study. Voriconazole concentrations were collected in a period on ECMO and before/after ECMO treatment. Multivariate analyses were performed to evaluate the effect of ECMO on voriconazole exposure and to assess the impact of possible saturation of the circuit’s binding sites over time. Results: Sixty-nine patients and 337 samples (190 during and 147 before/after ECMO) were analyzed. Subtherapeutic concentrations (<2 mg/L) were observed in 56% of the samples during ECMO and 39% without ECMO (p = 0.80). The median trough concentration, for a similar daily dose, was 2.4 (1.2–4.7) mg/L under ECMO and 2.5 (1.4–3.9) mg/L without ECMO (p = 0.58). Extensive inter-and intrasubject variability were observed. Neither ECMO nor squared day of ECMO (saturation) were retained as significant covariates on voriconazole exposure. Conclusions: No significant ECMO-effect was observed on voriconazole exposure. A large proportion of patients had voriconazole subtherapeutic concentrations.
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spelling pubmed-83031582021-07-25 A Large Retrospective Assessment of Voriconazole Exposure in Patients Treated with Extracorporeal Membrane Oxygenation Van Daele, Ruth Bekkers, Britt Lindfors, Mattias Broman, Lars Mikael Schauwvlieghe, Alexander Rijnders, Bart Hunfeld, Nicole G. M. Juffermans, Nicole P. Taccone, Fabio Silvio Coimbra Sousa, Carlos Antônio Jacquet, Luc-Marie Laterre, Pierre-François Nulens, Eric Grootaert, Veerle Lyster, Haifa Reed, Anna Patel, Brijesh Meersseman, Philippe Debaveye, Yves Wauters, Joost Vandenbriele, Christophe Spriet, Isabel Microorganisms Article Background: Voriconazole is one of the first-line therapies for invasive pulmonary aspergillosis. Drug concentrations might be significantly influenced by the use of extracorporeal membrane oxygenation (ECMO). We aimed to assess the effect of ECMO on voriconazole exposure in a large patient population. Methods: Critically ill patients from eight centers in four countries treated with voriconazole during ECMO support were included in this retrospective study. Voriconazole concentrations were collected in a period on ECMO and before/after ECMO treatment. Multivariate analyses were performed to evaluate the effect of ECMO on voriconazole exposure and to assess the impact of possible saturation of the circuit’s binding sites over time. Results: Sixty-nine patients and 337 samples (190 during and 147 before/after ECMO) were analyzed. Subtherapeutic concentrations (<2 mg/L) were observed in 56% of the samples during ECMO and 39% without ECMO (p = 0.80). The median trough concentration, for a similar daily dose, was 2.4 (1.2–4.7) mg/L under ECMO and 2.5 (1.4–3.9) mg/L without ECMO (p = 0.58). Extensive inter-and intrasubject variability were observed. Neither ECMO nor squared day of ECMO (saturation) were retained as significant covariates on voriconazole exposure. Conclusions: No significant ECMO-effect was observed on voriconazole exposure. A large proportion of patients had voriconazole subtherapeutic concentrations. MDPI 2021-07-20 /pmc/articles/PMC8303158/ /pubmed/34361978 http://dx.doi.org/10.3390/microorganisms9071543 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Van Daele, Ruth
Bekkers, Britt
Lindfors, Mattias
Broman, Lars Mikael
Schauwvlieghe, Alexander
Rijnders, Bart
Hunfeld, Nicole G. M.
Juffermans, Nicole P.
Taccone, Fabio Silvio
Coimbra Sousa, Carlos Antônio
Jacquet, Luc-Marie
Laterre, Pierre-François
Nulens, Eric
Grootaert, Veerle
Lyster, Haifa
Reed, Anna
Patel, Brijesh
Meersseman, Philippe
Debaveye, Yves
Wauters, Joost
Vandenbriele, Christophe
Spriet, Isabel
A Large Retrospective Assessment of Voriconazole Exposure in Patients Treated with Extracorporeal Membrane Oxygenation
title A Large Retrospective Assessment of Voriconazole Exposure in Patients Treated with Extracorporeal Membrane Oxygenation
title_full A Large Retrospective Assessment of Voriconazole Exposure in Patients Treated with Extracorporeal Membrane Oxygenation
title_fullStr A Large Retrospective Assessment of Voriconazole Exposure in Patients Treated with Extracorporeal Membrane Oxygenation
title_full_unstemmed A Large Retrospective Assessment of Voriconazole Exposure in Patients Treated with Extracorporeal Membrane Oxygenation
title_short A Large Retrospective Assessment of Voriconazole Exposure in Patients Treated with Extracorporeal Membrane Oxygenation
title_sort large retrospective assessment of voriconazole exposure in patients treated with extracorporeal membrane oxygenation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8303158/
https://www.ncbi.nlm.nih.gov/pubmed/34361978
http://dx.doi.org/10.3390/microorganisms9071543
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